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Janssen H, Bird ML, Luker J, Sellar B, Berndt A, Ashby S, McCluskey A, Ada L, Blennerhassett J, Bernhardt J, Spratt NJ. Impairments, and physical design and culture of a rehabilitation unit influence stroke survivor activity: qualitative analysis of rehabilitation staff perceptions. Disabil Rehabil 2022; 44:8436-8441. [PMID: 35113761 DOI: 10.1080/09638288.2021.2019840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to investigate rehabilitation staff perceptions of factors influencing stroke survivor activity outside of dedicated therapy time for the purpose of supporting successful translation of activity promoting interventions in a rehabilitation unit. MATERIALS AND METHODS Purposive sampling of multi-disciplinary teams from four rehabilitation units was performed, and semi-structured interviews were conducted by telephone, digitally audio-recorded and then transcribed verbatim. A stepped iterative process of thematic analysis was employed until data saturation was reached. RESULTS All but one of the 22 participants were female, the majority were either physiotherapists or occupational therapists, with a median of 4 years (interquartile range, 2-10) working at their respective rehabilitation units. Analysis of the data revealed three themes: (i) stroke survivor characteristics influence their activity outside therapy, (ii) the rehabilitation environment influences physical, cognitive, and social activity, and (iii) institutional priorities, staff culture, and attitude can be barriers to activity. Rehabilitation units were perceived to be unstimulating, and visitors considered enablers of activity when resources were perceived to be scarce. CONCLUSIONS Our results suggest careful consideration of the involvement of visitors, an individual's needs and preferences, and the institution's priorities and staff attitude may result in greater stroke survivor activity during rehabilitation.Implications for rehabilitationStaff should consider stroke survivor impairments and a rehabilitation unit's institutional priorities and staff attitudes when aiming to enhance stroke survivor engagement in activity.The physical and social environment of a rehabilitation unit can be optimised by rehabilitation staff to promote activity.Utilisation of visitors of stroke survivors on a rehabilitation unit may be one way to enhance engagement in activity.Discussion within the rehabilitation team concerning "ownership" of the role of supporting stroke survivor activity outside of structured therapy time may support better engagement in same.
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Affiliation(s)
- Heidi Janssen
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute and Hunter New England Local Health District, New Lambton Heights, Australia
| | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Julie Luker
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Ben Sellar
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Angela Berndt
- International Centre for Allied Health Evidence (iCAHE), Adelaide, Australia.,Occupational Therapy Australia (OTA), Fitzroy, Australia
| | - Samantha Ashby
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Annie McCluskey
- School of Health Sciences, The University of Sydney, Sydney, Australia.,The StrokeEd Collaboration, Sydney, Australia
| | - Louise Ada
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | | | - Julie Bernhardt
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Recovery, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne Australia
| | - Neil J Spratt
- School of Biomedical Sciences and Pharmacy, University of Newcastle and Hunter New England Local Health District, New Lambton Heights, Australia
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Luker J, Strik M, Raymond-Paquin A, Elrefai MH, Cano Perez O, Franqui-Rivera H, Pott A, Veltmann C, Schmitt J, Collinson J, Van Stipdonk AMW, Fluschnik N, Haeberiln A, Andrade J, Steven D. Incidence of premature battery depletion in subcutaneous cardioverter-defibrillator patients. Insights from a multicenter registry. Europace 2022. [DOI: 10.1093/europace/euac053.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
A subset of more than 35,000 S-ICD is under FDA advisory, warning of the potential of premature battery depletion (PBD), caused by a faulty low-voltage capacitor. Based on internal data, the manufacturer projects the incidence at 3.7% after 5 years. Data independent from the manufacturer is sparse.
Methods
This study was a multicenter effort of 14 centers in Europe, the US, and Canada. Consecutive patients who received a S-ICD at the participating centers were included in this retrospective analysis. Patients with the 1010 S-ICD generator model, and those without available follow-up information were excluded. Data was collected and managed using REDCap electronic data capture tools hosted at the University Hospital Cologne.
The primary endpoint in this registry was device explantation, generator replacement, or generator failure. Reasons for explantation, replacement, or failure were collected. Device longevity was defined in months. It was calculated as the time from device insertion to the time of replacement, or explantation, or failure, where applicable. Premature battery depletion was defined as the occurrence of battery depletion requiring generator replacement after 60 months or less.
The study complies with the Declaration of Helsinki. Ethics committee approval was obtained. This study is registered with Clinicaltrials.gov.
Results
Data of n=1,102 S-ICD devices was analyzed. The registry comprised of S-ICD generators implanted between 03/2015 and 09/2021 (43.4% A209 model and 56.6% A219 model). Of these, 611 devices (55.4%) were identified by the Boston Scientific serial number lookup tool as affected by the advisory. The mean and median follow-up duration was 2.43±1.66 and 2.29 years, respectively.
During follow-up, 110 devices (10%) were explanted after 2.9±1.7 years. Battery depletion was the indication in 52. The endpoint of PBD (battery depletion after less than 5 years) was met in 37 devices (6% of the devices under advisory), after 4.1±0.6 years.
In 58 cases, the S-ICD was explanted for reasons other than battery depletion.
Infection (16), system upgrade (20), heart transplant or LVAD therapy (7), and inappropriate shocks or inappropriate sensing (7) were the most common indications.
Discussion
This registry provides a systematic and manufacturer independent analysis of premature battery depletion in S-ICD patients. In the affected devices, the incidence of premature battery occurred in 6%. This is higher than what is projected by the manufacturer. The rate of PBD increases notably around the 4-year mark.
Conclusion
S-ICD generators under advisory suffer from PBD at a higher incidence than previously reported. Patients equipped with these devices should be closely monitored.
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Affiliation(s)
- J Luker
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - M Strik
- Cardio-Thoracic Research Centre of Bordeaux, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - A Raymond-Paquin
- Virginia Commonwealth University, Pauley Heart Center, Richmond, United States of America
| | - MH Elrefai
- University Hospital Southampton NHS Foundation Trust, Division of Cardiology, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - O Cano Perez
- Hospital Universitario y Politecnico La Fe, Unidad de Arritmias, Servicio de Cardiología, Valencia, Spain
| | - H Franqui-Rivera
- University of Puerto Rico, Department of Medicine, Cardiovascular Disease Division, San Juan, Puerto Rico
| | - A Pott
- University Hospital of Ulm, Department of Internal Medicine II, Ulm, Germany
| | - C Veltmann
- University Hospital, Hannover Herzrhythmus Centrum, Hannover, Germany
| | - J Schmitt
- University Hospital Giessen And Marburg, Medizinische Klinik I, Abteilung für Kardiologie, Giessen, Germany
| | - J Collinson
- Essex Cardiothoracic Centre, Department of Cardiac Electrophysiology, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - AMW Van Stipdonk
- Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, Maastricht, Netherlands (The)
| | - N Fluschnik
- University Heart Centre Hamburg, Hamburg, Germany
| | - A Haeberiln
- Inselspital - University of Bern, Bern, Switzerland
| | - J Andrade
- University of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - D Steven
- Cologne University Hospital - Heart Center, Cologne, Germany
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Janssen H, Bird ML, Luker J, McCluskey A, Blennerhassett J, Ada L, Bernhardt J, Spratt NJ. Stroke survivors' perceptions of the factors that influence engagement in activity outside dedicated therapy sessions in a rehabilitation unit: A qualitative study. Clin Rehabil 2022; 36:822-830. [PMID: 35290136 DOI: 10.1177/02692155221087424] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate stroke survivors' perceptions of factors influencing their engagement in activity outside of dedicated therapy sessions during inpatient rehabilitation. DESIGN Qualitative study. SETTING Four metropolitan rehabilitation units in Australia. PARTICIPANTS People undertaking inpatient rehabilitation after stroke. METHODS Semi-structured interviews conducted in person by a speech pathologist A stepped iterative process of inductive analysis was employed until data saturation was achieved with themes then applied against the three domains of the Theory of Planned Behaviour (perceived behavioural control, social norms and attitude). RESULTS Interviews of 33 stroke survivors (60% female, median age of 73 years) revealed five themes (i) uncertainty about how to navigate and what was available for use in the rehabilitation unit restricts activity and (ii) post-stroke mobility, fatigue and pre- and post-stroke communication impairments restrict activity (perceived behavioural control); (iii) unit set up, rules (perceived and actual) and staff expectations influence activity and (iv) visiting family and friends are strong facilitators of activity (social norms), and (v) personal preferences and mood influence level of activity (attitude). CONCLUSION At the individual level, stroke survivors perceived that their ability to be active outside of dedicated therapy sessions was influenced by their impairments, including mood, and their attitude towards and preference for activity. At the ward level, stroke survivors perceived that their ability to be active was influenced by ward set-up, rules and staff expectations. Visitors were perceived to be important facilitators of activity outside of therapy sessions.
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Affiliation(s)
- Heidi Janssen
- School of Health Sciences, 5982University of Newcastle, Newcastle, NSW, Australia.,454568Hunter Medical Research Institute and Hunter New England Local Health District, Australia
| | | | | | - Annie McCluskey
- The University of Sydney, Australia.,The StrokeEd Collaboration, Australia
| | | | | | - Julie Bernhardt
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Recovery, Australia.,Florey Institute of Neuroscience and Mental Health, Australia
| | - Neil J Spratt
- 454568Hunter Medical Research Institute and Hunter New England Local Health District, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle and Hunter New England Local Health District, Australia
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Gunn KM, Luker J, Ramanathan R, Skrabal Ross X, Hutchinson A, Huynh E, Olver I. Choosing and Managing Aged Care Services from Afar: What Matters to Australian Long-Distance Care Givers. Int J Environ Res Public Health 2021; 18:ijerph182413000. [PMID: 34948609 PMCID: PMC8701222 DOI: 10.3390/ijerph182413000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 11/16/2022]
Abstract
This research aims to identify the factors that influence caregivers' decisions about the aged care providers they select for their elder relatives when caring from a distance and what they value once they have engaged a service. Adult long-distance carers for older relatives living within Australia were purposively sampled and they participated in audio-recorded interviews. A thematic analysis was employed to investigate the data. A sample of 13 participants enabled data saturation with no new major themes identified in the final three interviews. Participants were 50 to 65 years (Mean = 59.8) and mostly (77%) female. Four themes emerged relating to selection of care providers: (1) availability of care, (2) financial arrangements, (3) proximity and location, and (4) reputation of care provider. Five themes detailed valued qualities of care: (1) vigilant monitoring and responsivity, (2) communication with family, (3) flexibility and proactiveness of care, (4) staffing, and (5) access to appropriate and holistic care to maintain wellbeing. Long-distance caregivers face barriers in selecting and managing aged care services from afar within a complex Australian aged care system. They strongly value regular, proactive communication about the wellbeing of their relatives and may be particular beneficiaries of communication and assistive monitoring technologies.
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Affiliation(s)
- Kate M. Gunn
- Department of Rural Health, University of South Australia, Adelaide, SA 5000, Australia;
- Correspondence:
| | - Julie Luker
- Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia;
| | - Rama Ramanathan
- Commission on Excellence and Innovation in Health, Adelaide, SA 5000, Australia;
| | - Xiomara Skrabal Ross
- Department of Rural Health, University of South Australia, Adelaide, SA 5000, Australia;
| | - Amanda Hutchinson
- Justice and Society, University of South Australia, Magill, SA 5072, Australia;
| | - Elisabeth Huynh
- Department of Health Services Research & Policy, The Australian National University, Acton, ACT 2601, Australia;
| | - Ian Olver
- School of Psychology, The University of Adelaide, Adelaide, SA 5000, Australia;
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Rama S, Atisha D, Evangelista M, Cannella C, Barry R, Ghosh S, Luker J, Chen Y, Zhu S, Bensenhaver J, Levin K, Walker E. The Effect of Oncoplastic Reduction on The Incidence of Post-Operative Lymphedema in Breast Cancer Patients Undergoing Lumpectomy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shipley J, Luker J, Thijs V, Bernhardt J. How can stroke care be improved for younger service users? A qualitative study on the unmet needs of younger adults in inpatient and outpatient stroke care in Australia. Disabil Rehabil 2019; 42:1697-1704. [DOI: 10.1080/09638288.2018.1534278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jessica Shipley
- Royal Melbourne Hospital, Melbourne, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Julie Luker
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Neurology Department, Austin Health, Melbourne, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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Abstract
OBJECTIVES To examine the personal and social experiences of younger adults after stroke. DESIGN Qualitative study design involving in-depth semi-structured interviews and rigorous qualitative descriptive analysis informed by social constructionism. PARTICIPANTS Nineteen younger stroke survivors aged 18 to 55 years at the time of their first-ever stroke. SETTING Participants were recruited from urban and rural settings across Australia. Interviews took place in a clinic room of the Florey Institute of Neuroscience and Mental Health (Melbourne, Australia), over an online conference platform or by telephone. RESULTS Four main themes emerged from the discourses: (1) psycho-emotional experiences after young stroke; (2) losing pre-stroke life construct and relationships; (3) recovering and adapting after young stroke; and (4) invalidated by the old-age, physical concept of stroke. While these themes ran through the narratives of all participants, data analysis also drew out interesting variation between individual experiences. CONCLUSIONS For many younger adults, stroke is an unexpected and devastating life event that profoundly diverts their biography and presents complex and continued challenges to fulfilling age-normative roles. While adaptation, resilience and post-traumatic growth are common, this study suggests that more bespoke support is needed for younger adults after stroke. Increasing public awareness of young stroke is also important, as is increased research attention to this problem.
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Affiliation(s)
- Jessica Shipley
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Julie Luker
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Neurology Department, Austin Health, Melbourne, Victoria, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
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McEvoy MP, Lewis LK, Luker J. Changes in physiotherapy students' knowledge and perceptions of EBP from first year to graduation: a mixed methods study. BMC Med Educ 2018; 18:109. [PMID: 29751804 PMCID: PMC5948852 DOI: 10.1186/s12909-018-1212-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Dedicated Evidence-Based Practice (EBP) courses are often included in health professional education programs. It is important to understand the effectiveness of this training. This study investigated EBP outcomes in entry-level physiotherapy students from baseline to completion of all EBP training (graduation). METHODS Mixed methods with an explanatory sequential design. Physiotherapy students completed two psychometrically-tested health professional EBP instruments at baseline and graduation. The Evidence-Based Practice Profile questionnaire collected self-reported data (Terminology, Confidence, Practice, Relevance, Sympathy), and the Knowledge of Research Evidence Competencies instrument collected objective data (Actual Knowledge). Focus groups with students were conducted at graduation to gain a deeper understanding of the factors impacting changes in students' EBP knowledge, attitudes, behaviour and competency. Descriptive statistics, paired t-tests, 95% CI and effect sizes (ES) were used to examine changes in outcome scores from baseline to graduation. Transcribed focus group data were analysed following a qualitative descriptive approach with thematic analysis. A second stage of merged data analysis for mixed methods studies was undertaken using side-by-side comparisons to explore quantitatively assessed EBP measures with participants' personal perceptions. RESULTS Data were analysed from 56 participants who completed both instruments at baseline and graduation, and from 21 focus group participants. Large ES were reported across most outcomes: Relevance (ES 2.29, p ≤ 0.001), Practice (1.8, p ≤ 0.001), Confidence (1.67, p ≤ 0.001), Terminology (3.13, p ≤ 0.001) and Actual Knowledge (4.3, p ≤ 0.001). A medium ES was found for Sympathy (0.49, p = 0.008). Qualitative and quantitative findings mostly aligned but for statistical terminology, participants' self-reported understanding was disparate with focus group reported experiences. Qualitative findings highlighted the importance of providing relevant context and positive role models for students during EBP training. CONCLUSIONS Following EBP training across an entry-level physiotherapy program, there were qualitative and significant quantitative changes in participants' knowledge and perceptions of EBP. The qualitative and quantitative findings were mainly well-aligned with the exception of the Terminology domain, where the qualitative findings did not support the strength of the effect reported quantitatively. The findings of this study have implications for the timing and content of EBP curricula in entry-level health professional programs.
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Affiliation(s)
- Maureen P. McEvoy
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
- School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
| | - Lucy K. Lewis
- School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University/Health Sciences Building, Repatriation General Hospital, 210 -216 Daws Rd, Daw Park, Adelaide, South Australia 5041 Australia
| | - Julie Luker
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
- School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
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Luker J, Murray C, Lynch E, Bernhardsson S, Shannon M, Bernhardt J. Carers' Experiences, Needs, and Preferences During Inpatient Stroke Rehabilitation: A Systematic Review of Qualitative Studies. Arch Phys Med Rehabil 2017; 98:1852-1862.e13. [DOI: 10.1016/j.apmr.2017.02.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/30/2017] [Accepted: 02/25/2017] [Indexed: 10/19/2022]
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Kenah K, Bernhardt J, Cumming T, Spratt N, Luker J, Janssen H. Boredom in patients with acquired brain injuries during inpatient rehabilitation: a scoping review. Disabil Rehabil 2017; 40:2713-2722. [DOI: 10.1080/09638288.2017.1354232] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katrina Kenah
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Julie Bernhardt
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience & Mental Health, Heidelberg, VIC, Australia
| | - Toby Cumming
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience & Mental Health, Heidelberg, VIC, Australia
| | - Neil Spratt
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Science and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Julie Luker
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience & Mental Health, Heidelberg, VIC, Australia
- International Centre for Allied Health Evidence, Sansom Institute, University of South Australia, Adelaide, SA, Australia
| | - Heidi Janssen
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
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Bennett L, Luker J, English C, Hillier S. Stroke survivors' perspectives on two novel models of inpatient rehabilitation: seven-day a week individual therapy or five-day a week circuit class therapy. Disabil Rehabil 2015; 38:1397-406. [PMID: 26600073 DOI: 10.3109/09638288.2015.1103788] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To explore stroke survivors' perspectives of two novel models of inpatient physiotherapy, which provide an increased amount of therapy: five days a week circuit class therapy and seven days a week individual therapy. METHOD This is a qualitative descriptive study using semi-structured interviews and thematic analysis. The participants were 10 purposively sampled stroke survivors in the post-acute phase of recovery, who had experienced seven days a week individual therapy or five days a week circuit group therapy during inpatient rehabilitation. RESULTS Three main themes emerged from the data: Too much, too little or just right; My experience - alone and together; and Meeting my needs. Findings revealed considerable variety in participants' beliefs, priorities and preferences regarding how intensely they could work; their experience of success and challenge individually and collectively; and their need to have their own unique individual needs met. Lack of choice seemed to be a linking concept between the themes. CONCLUSION In order to provide patient-centred services, novel methods of increased therapy must take into consideration the individual needs and preferences of the people accessing them. One model may not meet all these needs, hence a "menu" of options for therapy sessions (different timing, frequency, duration, content, rest and supervision) may be required to accommodate the diversity of patient needs, preferences and capacities. Implications for Rehabilitation People with stroke have diverse needs and preferences regarding the modes of delivering more therapy during rehabilitation. These diverse needs may not be met by one rigid service model. Therapists and service providers could engage their clients in a dialogue about the need for more therapy and how it can be delivered. This dialogue could include options of the various ways to increase their therapy. Therapists need to provide clear reasons and education around therapy components, including rest time and practice schedules.
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Affiliation(s)
- Leanne Bennett
- a International Centre for Allied Health Evidence, School of Health Sciences , University of South Australia , Adelaide , Australia
| | - Julie Luker
- a International Centre for Allied Health Evidence, School of Health Sciences , University of South Australia , Adelaide , Australia
| | - Coralie English
- a International Centre for Allied Health Evidence, School of Health Sciences , University of South Australia , Adelaide , Australia
| | - Susan Hillier
- a International Centre for Allied Health Evidence, School of Health Sciences , University of South Australia , Adelaide , Australia
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Luker J, Lynch E, Bernhardsson S, Bennett L, Bernhardt J. Stroke Survivors' Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Studies. Arch Phys Med Rehabil 2015; 96:1698-708.e10. [PMID: 25847387 DOI: 10.1016/j.apmr.2015.03.017] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/17/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To report and synthesize the perspectives, experiences, and preferences of stroke survivors undertaking inpatient physical rehabilitation through a systematic review of qualitative studies. DATA SOURCES MEDLINE, CINAHL, Embase, and PsycINFO were searched from database inception to February 2014. Reference lists of relevant publications were searched. All languages were included. STUDY SELECTION Qualitative studies reporting stroke survivors' experiences of inpatient stroke rehabilitation were selected independently by 2 reviewers. The search yielded 3039 records; 95 full-text publications were assessed for eligibility, and 32 documents (31 studies) were finally included. Comprehensiveness and explicit reporting were assessed independently by 2 reviewers using the consolidated criteria for reporting qualitative research framework. Discrepancies were resolved by consensus. DATA EXTRACTION Data regarding characteristics of the included studies were extracted by 1 reviewer, tabled, and checked for accuracy by another reviewer. All text reported in studies' results sections were entered into qualitative data management software for analysis. DATA SYNTHESIS Extracted texts were inductively coded and analyzed in 3 phases using thematic synthesis. Nine interrelated analytical themes, with descriptive subthemes, were identified that related to issues of importance to stroke survivors: (1) physical activity is valued; (2) bored and alone; (3) patient-centered therapy; (4) recreation is also rehabilitation; (5) dependency and lack of control; (6) fostering autonomy; (7) power of communication and information; (8) motivation needs nurturing; and (9) fatigue can overwhelm. CONCLUSIONS The thematic synthesis provides new insights into stroke survivors' experiences of inpatient rehabilitation. Negative experiences were reported in all studies and include disempowerment, boredom, and frustration. Rehabilitation could be improved by increasing activity within formal therapy and in free time, fostering patients' autonomy through genuinely patient-centered care, and more effective communication and information. Future stroke rehabilitation research should take into account the experiences and preferences of stroke survivors.
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Affiliation(s)
- Julie Luker
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
| | - Elizabeth Lynch
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Susanne Bernhardsson
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia; Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden; Närhälsan Hönö/Öckerö Rehabilitation, Region Västra Götaland, Sweden
| | - Leanne Bennett
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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Grimmer K, Dizon JM, Milanese S, King E, Beaton K, Thorpe O, Lizarondo L, Luker J, Machotka Z, Kumar S. Efficient clinical evaluation of guideline quality: development and testing of a new tool. BMC Med Res Methodol 2014; 14:63. [PMID: 24885893 PMCID: PMC4033487 DOI: 10.1186/1471-2288-14-63] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/22/2014] [Indexed: 11/16/2022] Open
Abstract
Background Evaluating the methodological quality of clinical practice guidelines is essential before deciding which ones which could best inform policy or practice. One current method of evaluating clinical guideline quality is the research-focused AGREE II instrument. This uses 23 questions scored 1–7, arranged in six domains, which requires at least two independent testers, and uses a formulaic weighted domain scoring system. Following feedback from time-poor clinicians, policy-makers and managers that this instrument did not suit clinical need, we developed and tested a simpler, shorter, binary scored instrument (the iCAHE Guideline Quality Checklist) designed for single users. Methods Content and construct validity, inter-tester reliability and clinical utility were tested by comparing the new iCAHE Guideline Quality Checklist with the AGREE II instrument. Firstly the questions and domains in both instruments were compared. Six randomly-selected guidelines on a similar theme were then assessed by three independent testers with different experience in guideline quality assessment, using both instruments. Per guideline, weighted domain and total AGREE II scores were calculated, using the scoring rubric for three testers. Total iCAHE scores were calculated per guideline, per tester. The linear relationship between iCAHE and AGREE II scores was assessed using Pearson r correlation coefficients. Score differences between testers were assessed for the iCAHE Guideline Quality Checklist. Results There were congruent questions in each instrument in four domains (Scope & Purpose, Stakeholder involvement, Underlying evidence/Rigour, Clarity). The iCAHE and AGREE II scores were moderate to strongly correlated for the six guidelines. There was generally good agreement between testers for iCAHE scores, irrespective of their experience. The iCAHE instrument was preferred by all testers, and took significantly less time to administer than the AGREE II instrument. However, the use of only three testers and six guidelines compromised study power, rendering this research as pilot investigations of the psychometric properties of the iCAHE instrument. Conclusion The iCAHE Guideline Quality Checklist has promising psychometric properties and clinical utility.
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Affiliation(s)
- Karen Grimmer
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, City East Campus, School of Health Sciences, Centenary, GPO box 2471, Adelaide 5001, Australia.
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Dones VC, Grimmer K, Thoirs K, Suarez CG, Luker J. The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review. BMC Med Imaging 2014; 14:10. [PMID: 24589069 PMCID: PMC4015882 DOI: 10.1186/1471-2342-14-10] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 02/17/2014] [Indexed: 11/17/2022] Open
Abstract
Background Ultrasound is considered a reliable, widely available, non-invasive and inexpensive imaging technique for assessing soft tissue involvement in Lateral epicondylalgia. Despite the number of diagnostic studies for Lateral Epicondylalgia, there is no consensus in the current literature on the best abnormal ultrasound findings that confirm lateral epicondylalgia. Methods Eligible studies identified by searching electronic databases, scanning reference lists of articles and chapters on ultrasound in reference books, and consultation of experts in sonography. Three reviewers (VCDIII, KP, KW) independently searched the databases using the agreed search strategy, and independently conducted all stages of article selection. Two reviewers (VCDIII, KP) then screened titles and abstracts to remove obvious irrelevance. Potentially relevant full text publications which met the inclusion criteria were reviewed by the primary investigator (VCDIII) and another reviewer (CGS). Results Among the 15 included diagnostic studies in this review, seven were Level II diagnostic accuracy studies for chronic lateral epicondylalgia based on the National Health and Medical Research Council Hierarchy of Evidence. Based from the pooled sensitivity of abnormal ultrasound findings with homogenous results (p > 0.05), the hypoechogenicity of the common extensor origin has the best combination of diagnostic sensitivity and specificity. It is moderately sensitive [Sensitivity: 0.64 (0.56-0.72)] and highly specific [Specificity: 0.82 (0.72-0.90)] in determining elbows with lateral epicondylalgia. Additionally, bone changes on the lateral epicondyle [Sensitivity: 0.56 (0.50-0.62)] were moderately sensitive to chronic LE. Conversely, neovascularity [Specificity: 1.00 (0.97-1.00)], calcifications [Specificity: 0.97 (0.94-0.99)] and cortical irregularities [Specificity: 0.96 (0.88-0.99)] have strong specificity for chronic lateral epicondylalgia. There is insufficient evidence supporting the use of Power Doppler Ultrasonogrophy, Real-time Sonoelastography and sonographic probe-induced tenderness in diagnosing LE. Conclusions The use of Gray-scale Ultrasonography is recommended in objectively diagnosing lateral epicondylalgia. The presence of hypoechogenicity and bone changes indicates presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia. In addition to diagnosis, detection of these abnormal ultrasound findings allows localization of pathologies to tendon or bone that would assist in designing an appropriate treatment suited to patient’s condition.
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Affiliation(s)
- Valentin C Dones
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia.
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16
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Grimmer K, Luker J, Beaton K, Kumar S, Crockett A, Price K. TRialing individualized interventions to prevent functional decline in at-risk older adults (TRIIFL): study protocol for a randomized controlled trial nested in a longitudinal observational study. Trials 2013; 14:266. [PMID: 23962259 PMCID: PMC3765328 DOI: 10.1186/1745-6215-14-266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 08/06/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Functional decline (FD) is a largely preventable feature of aging, characterized as gradual erosion of functional autonomy. This reduces an older person's capacity for safe, independent community living. The healthcare needs of an unprecedented aging population places pressure on health systems to develop innovative approaches to ensuring older people live healthy and independent lives for as long as possible. TRIIFL aims to demonstrate that: 1. Incipient FD in older people can be identified using a simple telephone-screening process within four weeks of discharge from an emergency department presentation for a minor health event; and 2. Early engagement into a person-centered individualized intervention arrests or reduces the rate of FD over the next 12 months. METHODS/DESIGN A randomized controlled trial (RCT) nested within a 13-month longitudinal cohort study. The RCT (conducted over 12 months) tests the effectiveness of a novel, early, home-based, personalized program (compared with no intervention) in arresting or slowing FD. TRIIFL focuses on older adults living independently in the community, who have not yet had a serious health event, yet are potentially on the cusp of FD. Participants in the longitudinal cohort study will be recruited as they present to one large tertiary hospital Emergency Department, providing they are not subsequently admitted to a ward. Sample size calculations indicate that 570 participants need to be recruited into the longitudinal study, with 100 participants randomized into the trial arms. Measures from all subjects will be taken face-to-face at baseline (recruitment), then subsequently by telephone at one, four, seven and thirteen months later. Measures include functional abilities, quality of life, recent falls, mobility dependence, community supports and health service usage. Specific to the nested RCT, the quality of life tool (SF12) applied at one month, will identify individuals with low mental component quality of life scores, who will be invited to enter the RCT.Assessors will be blinded to RCT arm allocation, and subjects in the RCT will be blinded to the intervention being received by other subjects. TRIALS REGISTRATION Australian & New Zealand Clinical Trials Registry: ACTRN12613000234718.
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Affiliation(s)
- Karen Grimmer
- International Centre for Allied Health Evidence, University of South Australia, GPO Box 2471, Adelaide, South Australia, Australia
| | - Julie Luker
- International Centre for Allied Health Evidence, University of South Australia, GPO Box 2471, Adelaide, South Australia, Australia
| | - Kate Beaton
- International Centre for Allied Health Evidence, University of South Australia, GPO Box 2471, Adelaide, South Australia, Australia
| | - Saravana Kumar
- International Centre for Allied Health Evidence, University of South Australia, GPO Box 2471, Adelaide, South Australia, Australia
| | - Alan Crockett
- Exercise for Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Kay Price
- Safety and Quality in Health Research Group, University of South Australia, Adelaide, South Australia, Australia
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Grimmer-Somers K, Johnston K, Somers E, Luker J, Ann Alemao L, Jones D. A holistic client-centred program for vulnerable frequent hospital attenders: cost efficiencies and changed practices. Aust N Z J Public Health 2010; 34:609-12. [DOI: 10.1111/j.1753-6405.2010.00616.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
A 14-year-old female patient attended Bristol Dental Hospital for an oral screening prior to undergoing a bone marrow transplant as treatment for her acute lymphoblastic leukaemia. Maxillofacial radiographs revealed multiple, well-defined, non-corticated radiolucent lesions throughout the vault of her skull and mandible. These radiological features (coupled with the patient's age) would have correlated with a diagnosis of Langerhans cell histiocytosis. However, a previous bone marrow biopsy confirmed that the patient did indeed have acute lymphoblastic leukaemia. The lytic lesions were present throughout her entire skeletal frame and had previously led to episodes of leg and abdominal pain. We feel that this radiological presentation of leukaemia needs to be reported as these features could easily have been confused with other haematological or even malignant conditions.
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Affiliation(s)
- R Ali
- Department of Oral and Dental Science, Bristol Dental Hospital, Bristol, BS1 2LY, UK.
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19
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Abstract
Rationale, aim and objective The use of stroke clinical guidelines is widely encouraged yet variably operationalized. The factors which support, or hinder guideline compliance are poorly understood, and there is little research which pertains to the unique roles of Allied Health (AH) staff when operationalizing stroke clinical guidelines. This study identifies factors influencing AH staff compliance with guideline recommendations in an acute stoke unit. Method A retrospective audit was conducted of hospital records of stroke patients admitted to an Australian tertiary metropolitan hospital in 2005. The recorded clinical care provided by an AH team was audited against the 38 recommendations in the Australian acute stroke guidelines relevant to allied health. Results Compliance with guideline recommendations was variable, with better care compliance found for younger patients, patients admitted on weekdays, and patients with poorer functional ability on admission, longer lengths of stay and better functional improvements during admission. Compliance also reflected the congruence of guideline recommendations with 'usual practice'. Conclusions A number of factors influenced AH staff compliance with acute stroke guidelines. These findings are a platform upon which further implementation research can be launched for AH professionals.
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Affiliation(s)
- Julie Luker
- Physiotherapist & Allied Health Team Leader, Flinders Medical Centre, Bedford Park, South Australia, Australia.
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21
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Zanker K, English C, Prideaux N, Luker J. Interdisciplinary circuit class therapy: Increasing therapy time on an acute stroke unit. International Journal of Therapy and Rehabilitation 2007. [DOI: 10.12968/ijtr.2007.14.11.27597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kate Zanker
- Flinders Medical Centre, Bedford Park, South Australia, 5042
| | | | - Nicole Prideaux
- ANCER Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042
| | - Julie Luker
- ANCER Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042
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Robinson CM, Addy L, Wylie M, Luker J, Eveson JW, Prime SS. A study of the clinical characteristics of benign trigeminal sensory neuropathy. J Oral Maxillofac Surg 2003; 61:325-32. [PMID: 12618972 DOI: 10.1053/joms.2003.50057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to describe the clinical characteristics of a series of patients presenting with benign trigeminal sensory neuropathy. PATIENTS AND METHODS We conducted a retrospective analysis of the clinical and pathologic characteristics of 23 patients presenting with facial numbness of unknown etiology. RESULTS Patients presented with diverse medical histories but could be grouped into those with a connective tissue disorder, neurologic disease, psychologic problems, or a medical history of unknown significance. The age of the patient, the severity and distribution of the trigeminal neuropathy, and symptoms other than neuropathy closely reflected the patient's medical history. The majority of patients underwent magnetic resonance imaging, but the results did not facilitate the diagnosis of the condition or reflect the extent and severity of the symptoms. In 60% of patients, the symptoms remained unchanged during the course of the study and outcome was not influenced by medical treatment. CONCLUSIONS The diagnosis and management of benign trigeminal sensory neuropathy remain a significant clinical challenge.
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Affiliation(s)
- C M Robinson
- Division of Oral Medicine, Pathology and Microbiology, Department of Oral and Dental Science, University of Bristol, Bristol, United Kingdom
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23
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Luker J, Gniewek T, Johnson C. Saturation Composition of a Steam-Oxygen Liquid Water System and P-V-T Data for a Superheated Steam-Oxygen Mixture. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/i460003a002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brooke AE, Eveson JW, Luker J, Oakhill A. Oral presentation of a novel variant of herpes simplex infection in a group of bone marrow transplant patients: a report of five cases. Br J Dermatol 1999; 141:381-3. [PMID: 10468838 DOI: 10.1046/j.1365-2133.1999.03018.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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25
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Porter SR, Luker J, Scully C, Kumar N. Oral lesions in UK patients with or liable to HIV disease-ten years experience. Med Oral 1999; 4:455-469. [PMID: 11507520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- S.-R. Porter
- Department of Oral Medicine. Eastman Dental Institute and Hospital for Oral Health Care Sciences. London. UK
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26
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Abstract
Parietal foramina (Catlin marks) are developmental anomalies which affect approximately 1 in 25,000 people. They are thought to be inherited as an autosomal trait and may be associated with other skeletal anomalies such as cleft lip or palate. The majority of enlarged parietal foramina are usually completely asymptomatic.
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Affiliation(s)
- J Luker
- Division of Oral Medicine, Pathology and Microbiology, Bristol Dental School, Bristol, UK
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27
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Abstract
The demographics of 147 HIV-infected persons attending a special care dental clinic in South West England are reported. The majority of attendants were homosexual/bisexual males, reflecting the UK epidemiology of HIV disease at the time of study. There was a substantial rise in patient numbers from 1988 onwards but patients often did not reveal their route of HIV acquisition or increasingly had acquired HIV disease via heterosexual routes. Patients were usually referred for routine dental treatment, not HIV-related oral disease. The HIV-infected patients generally attended the clinic irregularly, despite being offered many appointments. It is concluded that most patients with HIV disease attend clinics for routine dental care, yet many may be unable or unwilling to attend regularly.
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Affiliation(s)
- S R Porter
- Department of Oral Medicine, Eastman Dental Institute, London
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Johnson EM, Warnock DW, Luker J, Porter SR, Scully C. Emergence of azole drug resistance in Candida species from HIV-infected patients receiving prolonged fluconazole therapy for oral candidosis. J Antimicrob Chemother 1995; 35:103-14. [PMID: 7768758 DOI: 10.1093/jac/35.1.103] [Citation(s) in RCA: 181] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We examined the effect of different fluconazole treatment regimens on the emergence of azole drug resistance among Candida species recovered from the mouths of 54 HIV-infected individuals. Patients were assigned to one of three treatment groups depending on their history of oral candidosis and fluconazole use. Mouthwashes obtained at regular intervals were cultured and isolates identified using standard methods. Antifungal broth micro-dilution tests were performed to determine IC30s of fluconazole and ketoconazole. Sixty-four Candida albicans isolates from 20 patients with no evidence of oral candidosis who had not received fluconazole all had IC30s of < or = 4 mg/L. Thirty-four (83%) of 41 C. albicans isolates from ten patients receiving intermittent, short-term fluconazole treatment for oral candidosis had IC30s of < or = 4 mg/L, but only two isolates (5%) had IC30s > or = 64 mg/L. In contrast, 26 (40%) of 65 C. albicans isolates from 15 patients given long-term fluconazole (50-200 mg/day or 150 mg/week) were classified as resistant having IC30s of fluconazole of > or = 64 mg/L. Ten of these 26 fluconazole-resistant isolates were susceptible to ketoconazole with IC30s of < or = 4 mg/L suggesting azole drug cross-resistance is not inevitable. Tests on multiple colonies from individual isolation plates showed that it was not unusual to obtain differing IC30 values, indicating that a sweep inoculum is essential if resistance is to be detected. Nine (60%) of the 15 patients given long-term fluconazole harboured isolates of C. albicans that were resistant to fluconazole at some time during the study period. All had low CD4 counts and were approaching the final stage of their illness. Three patients on long-term treatment had resistant organisms at the outset of the study; in the remainder, resistant strains emerged during the study period. In six of the nine cases, emergence of resistance in vitro correlated with persistent clinical signs of oral infection. Thirty-six isolates of Candida species other than C. albicans were also recovered from patients receiving long-term fluconazole and 29 (81%) of these had IC30s of > or = 64 mg/L. Our experience with C. albicans in patients with HIV infection, suggests that the long-term azole drug use may be an important factor in the development of fluconazole resistance as such resistance was rare and transient in patients on intermittent short-term treatment.
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Affiliation(s)
- E M Johnson
- PHLS Mycology Reference Laboratory, Public Health Laboratory, Bristol, UK
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Porter SR, Sugerman PB, Scully C, Luker J, Oakhill A. Orofacial manifestations in the Wiskott-Aldrich syndrome. ASDC J Dent Child 1994; 61:404-407. [PMID: 7897015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- S R Porter
- Department of Oral Medicine, Eastman Dental Institute, London, U.K
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Abstract
The oral features of three members of a family with familial benign neutropenia (a mother and two children) are detailed. Prepubertal periodontitis, oral ulceration, and angular stomatitis were the principal features.
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Affiliation(s)
- S R Porter
- University Department of Oral Medicine, Pathology, and Microbiology, Bristol Dental School and Hospital, United Kingdom
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Scully C, Davies R, Porter S, Eveson J, Luker J. HIV-salivary gland disease. Salivary scintiscanning with technetium pertechnetate. Oral Surg Oral Med Oral Pathol 1993; 76:120-3. [PMID: 8394560 DOI: 10.1016/0030-4220(93)90306-o] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The salivary disease in two patients with human immunodeficiency virus infection was investigated by technetium pertechnetate scintiscanning. Although there was good histologic evidence of benign lymphoepithelial disease, scintiscanning failed to delineate any salivary lesions. Technetium pertechnetate scintiscanning seems to be of little value in the detailed investigation of salivary disease in human immunodeficiency virus infection, though gallium scanning can help. Fine needle aspiration or biopsy remain the main diagnostic tools.
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Affiliation(s)
- C Scully
- Centre for the Study of Oral Disease, University Department of Oral Medicine, Bristol, U.K
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Abstract
Post tooth extraction infective complications have occasionally been described in HIV-infected persons. However, there is little objective data as to the frequency of this and the need for antibiotic prophylaxis. Similarly the frequency of postextraction bleeding in patients infected with HIV, who may have thrombocytopenia, is unknown. In the present study the frequency of postextraction complications has been investigated in a group of 38 persons at stages 2 to 4 of HIV infection and 26 matched subjects from patients groups commonly at risk of HIV infection but not seropositive. During 40 clinical procedures in HIV-infected patients, 100 (range 1 to 23, median 1) teeth were extracted. Three episodes of delayed postextraction healing were recorded. During 30 procedures in the non-HIV-infected persons, 68 (range 1 to 5, median, 2) teeth were extracted, and two episodes of delayed postextraction healing were recorded. These differences were not significant. Only one HIV-infected patient had an episode of severe postextraction bleeding: this was a hemophiliac who bled despite receiving factor VIII prophylaxis. The bleeding occurred 7 days after the extraction and ceased with tranexamic acid and additional factor VIII. No control subject had severe postextraction hemorrhage. It is concluded that postextraction complications are uncommon in HIV-infected patients and that routine antibiotic prophylaxis is not indicated.
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Affiliation(s)
- S R Porter
- Centre for the Study of Oral Disease, University of Bristol Dental Hospital and School, England
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Affiliation(s)
- C Scully
- University Department of Oral Medicine, Surgery and Pathology, Bristol Dental Hospital and School
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Scully C, Epstein JB, Porter S, Luker J. Recognition of oral lesions of HIV infection. 3. Gingival and periodontal disease and less common lesions. Br Dent J 1990; 169:370-2. [PMID: 2275839 DOI: 10.1038/sj.bdj.4807387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This is the last of a series of three articles on the recognition of oral lesions of HIV infection. It deals with the less common, and some rare lesions.
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Affiliation(s)
- C Scully
- Department of Oral Medicine, Surgery and Pathology, Bristol Dental Hospital and School
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35
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Affiliation(s)
- C Scully
- Centre for the Study of Oral Diseases, University Department of Oral Medicine, Surgery and Pathology, Bristol Dental Hospital and School
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Abstract
Oral problems are often the first significant clinical manifestations of infection with human immunodeficiency virus (HIV). Their early recognition affords the best opportunity for effective therapeutic intervention of HIV infection and opportunistic infections, as well as for oral health education in order to avoid future problems. This also provides optimal time for behaviour modification and coming to terms with the psychosocial consequences of HIV disease. This series of three articles presents a pictorial review and update on the oral manifestations of HIV infection.
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Affiliation(s)
- C Scully
- Centre for the Study of Oral Diseases, University Department of Oral Medicine, Surgery and Pathology, Bristol Dental Hospital and School
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Abstract
The lateral medullary syndrome is a rare syndrome resulting from a cerebrovascular accident involving part of the medulla oblongata with consequent loss of pain and temperature sensation in the orofacial region, loss of taste, and palatal palsy and loss of gag reflex, together with Horner's syndrome and ataxia. A case is presented and the literature reviewed.
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Affiliation(s)
- J Luker
- University Department of Oral Medicine, Bristol Dental Hospital and School, England
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Luker J, Crane IJ, Scully C, Prime SS. The expression of anchorage independence by malignant rat oral keratinocytes after colony formation in vitro and tumour formation in vivo. Arch Oral Biol 1989; 34:867-73. [PMID: 2610620 DOI: 10.1016/0003-9969(89)90143-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The expression of anchorage independence in malignant oral epithelial cells retrieved from colonies formed in agarose and tumours formed in athymic mice was examined. The original epithelial cell lines were derived from lingual and palatal squamous cell carcinomas induced in rats by the carcinogen 4-nitroquinoline N-oxide. The capacity to express anchorage independence varied considerably between the original cell lines and essentially increased with passage in culture. In three out of four colony-derived subpopulations, the colony-forming efficiency was significantly greater than that of the original cell lines. Xenograft subpopulations expressed higher colony-forming efficiencies than their original counterparts in only two of five cell lines. Undifferentiated tumour xenografts resulted in more homogeneous tumour-derived subpopulations, in contrast to the more heterogeneous cell lines from well-differentiated tumours. The findings demonstrate functional diversity within and between malignant rat oral epithelial cell lines and their colony- and xenograft-derived subpopulations.
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Affiliation(s)
- J Luker
- University Department of Oral Medicine, Surgery and Pathology, Bristol Dental Hospital, England
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Luker J, Crane IJ, Scully C, Prime SS. The effect of 3T3 fibroblasts on the expression of anchorage independence and cornification of oral keratinocytes. Virchows Arch B Cell Pathol Incl Mol Pathol 1989; 57:19-26. [PMID: 2472034 DOI: 10.1007/bf02899061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study examined the effect of 3T3 fibroblasts on the expression of anchorage independence and the degree of cornification in early cultures of three carcinoma-derived epithelial cell lines (R59, R63a, R63b) and in one cell line derived from non-malignant dysplastic epithelium where there was no evidence of invasion (R66a). The epithelial cell lines originated from the palatal (R63a, R66a) and the lingual (R59, R63b) mucosa of rats that had been painted with the carcinogen 4-nitroquinoline N-oxide. In the absence of 3T3 fibroblasts, progressive culture resulted in an increase in the colony forming efficiency (CFE) of R63a, R63b and R59 and a decrease in the percentage of cornified cells in all cell lines. 3T3 fibroblasts caused a decrease in the CFE and the degree of cornification in the 3T3-dependent cell line (R63a), particularly at the lower passages, but these parameters remained essentially unchanged by 3T3 fibroblasts in the 3T3-independent cell lines (R59, R63b). 3T3 fibroblasts did not influence the cornification of R66a and this cell line remained anchorage dependent throughout the study. The results suggest that in malignant cell lines characterised by being independent of 3T3 fibroblasts (R63b, R59) the CFE was inversely correlated to the degree of cornification. However, in the malignant cell line showing a greater dependence on support (R63a) the relationship between CFE and cornification was unclear because these parameters may have been modulated by the presence of 3T3 fibroblasts. The cell line from dysplastic non-invasive tissue (R66a) differed from its malignant counterparts in the fact that CFE and cornification were unaffected by 3T3 fibroblasts despite previous studies showing a dependence on mesenchymal support.
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Affiliation(s)
- J Luker
- University Department of Oral Medicine, Surgery and Pathology, Bristol Dental Hospital, England
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Abstract
The orofacial manifestations of 44 HIV-infected individuals from the South West of England are reported. Oral candidiasis, periodontal disease and cervical lymphadenopathy were the most commonly observed disorders although hairy leukoplakia was also present in 15% of patients. The orofacial features of this group of British patients are similar to those of HIV-infected individuals from other parts of Europe, North America and Scandinavia.
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Affiliation(s)
- S R Porter
- University Department of Oral Medicine, Surgery and Pathology, Bristol Dental School and Hospital, England
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Crane IJ, Luker J, de Gay L, Rice SQ, Stone A, Scully C, Prime SS. Transformation of oral keratinocytes in vitro by 4-nitroquinoline N-oxide. Carcinogenesis 1988; 9:2251-6. [PMID: 2461265 DOI: 10.1093/carcin/9.12.2251] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Normal rat oral keratinocytes have been transformed with the carcinogen 4-nitroquinoline N-oxide (4NQO) in vitro. The morphology, growth characteristics, ability to grow without anchorage and tumorigenicity in athymic mice was examined in 12 selected cell lines. Each of the lines could be assigned to one of two general groups. The first group of cell lines although showing some morphological signs of transformation and the ability to be subcultured beyond passage 15 were not anchorage independent or able to form tumours in athymic mice. The second group of cell lines showed distinct signs of morphological transformation, could be serially subcultured without 3T3 feeder cells, were anchorage independent and tumorigenic in athymic mice. Anchorage independence was more common at higher passages and with increased 4NQO treatment and correlated well with a decreased reliance on 3T3 feeder cell support. The anchorage-independent phenotype was closely associated with the ability to form tumours in athymic mice. This same sequence of phenotypic changes has been demonstrated in rat oral keratinocytes after 4NQO treatment in vivo indicating that during carcinogenesis, cell populations progress through the same stages whether proliferation occurs in vitro or in vivo. There is some evidence to suggest, however, that the time interval between stages may be altered when carcinogenesis takes place in vitro.
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Affiliation(s)
- I J Crane
- University Department of Oral Medicine, Surgery and Pathology, University of Bristol Dental School, UK
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Luker J, Scully C. Paediatric oral medicine: 5. The oral mucosa (ii). Dent Update 1988; 15:370, 372-3. [PMID: 3272910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Luker J, Scully C. Paediatric oral medicine: 5. The oral mucosa (i). Dent Update 1988; 15:292-4, 296-8. [PMID: 3251800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Luker J, Scully C. Paediatric oral medicine: 3. The teeth. Dent Update 1988; 15:108, 110-4. [PMID: 3267583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Luker J, Scully C. Paediatric oral medicine: 2. Bony lesions and deformities of the face. Dent Update 1988; 15:15-8, 20-5. [PMID: 3181580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Luker J, De Gay L, Crane IJ, Stone A, Scully C, Prime SS. The inter-relationship between anchorage independence and tumorigenicity in early cultures of oral keratinocytes. Virchows Arch B Cell Pathol Incl Mol Pathol 1987; 54:246-51. [PMID: 2451343 DOI: 10.1007/bf02899218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study examines the expression of anchorage independence and tumorigenicity in early cultures of oral rat keratinocytes. The epithelial cell lines originated from the palatal and the lingual mucosa of rats that had been painted with the carcinogen 4-nitroquinoline N-oxide. The colony forming efficiency (CFE) in gel culture of the cell lines derived from five squamous cell carcinomas of the tongue and palate predominantly increased with passage in culture. Carcinoma-derived cell lines that had a relatively high CFE (greater than 2.5%) formed tumours when transplanted to athymic mice, but cells in which the CFE was less than 2.5% were non-tumorigenic. Keratinocytes from a dysplastic palatal lesion were immortal, anchorage dependent and non-tumorigenic. A lingual papilloma cell line consistently expressed a very low CFE but was tumorigenic at the higher culture passages. The results show that the routine passage of cells in culture leads to the emergence of the anchorage independent and tumorigenic phenotypes in keratinocytes of malignant origin and, further, suggest that anchorage independence and tumorigenicity may exist as distinct phenotypes, with anchorage independence preceding tumorigenicity.
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Affiliation(s)
- J Luker
- University Department of Oral Medicine and Oral Surgery, Bristol Dental Hospital, UK
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Luker J, Scully C. Paediatric oral medicine: 1. Soft tissue lesions of the face and neck. Dent Update 1987; 14:391-3, 396-9. [PMID: 3503794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Crane IJ, Luker J, Stone A, Scully C, Prime SS. Characterization of malignant rat keratinocytes in culture following the induction of oral squamous cell carcinomas in vivo. Carcinogenesis 1986; 7:1723-7. [PMID: 2428538 DOI: 10.1093/carcin/7.10.1723] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
An in vivo model of oral epithelial carcinogenesis in rats has been established successfully in cell culture. Oral carcinomas of the tongue and palate were induced in Sprague-Dawley male rats by painting their palates three times weekly for 7-8 months with 0.5% (w/v) 4-nitroquinoline-N-oxide. Oral keratinocytes from malignant and untreated control tissues were cultivated using 3T3 fibroblast support. Both the normal and malignant cells stained positively with an anti-human keratin polyclonal antibody but malignant keratinocytes were heterogeneous with regard to cell size, shape and intercellular packing, unlike the regular organization of the normal cultures. Malignant keratinocyte cultures differed markedly from their normal counterparts by an increase in their growth rate, the capacity for serial cultivation to the 25th passage (to date) and independence of 3T3 fibroblast support. In contrast, cultures established from healthy tissue showed signs of senescence usually by passage 4 and were totally reliant on 3T3 fibroblast support for growth. Malignant keratinocytes expressed anchorage independence when cultured in a semi-solid medium and gave rise to tumour formation in athymic mice. The development of this specialized cell culture system substantially increases the potential of the rat 4NQO model to investigate the pathogenesis of oral squamous cell carcinomas.
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Luker J, Crane I, Stone A, Scully C, Prime SS. The influence of substrate and initial cell number on the expression of anchorage independence by two malignant epithelial cell lines. Med Lab Sci 1986; 43:314-8. [PMID: 3657413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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